Thursday, February 28, 2008

Perspective

It all depends on your point of view. I have this old guy who came in last week with a bowel obstruction from an incarcerated ventral hernia. He's 88, frail, and a walking medical disaster; CHF, 20% ejection fraction, chronic renal failure, severe COPD, and untreated lung cancer. Well I took him for OR and fixed the hernia and the bowel looked viable and he went to the ICU extubated. The next day, he was still breathing on his own and his hemodynamic parameters, although not great, were fairly decent. As far as I was concerned, he looked pretty damn good, given the circumstances, and I wrote as such in my progress note. When I stopped by later in the evening, I reviewed the chart to see what the other consultants were writing (surgeons like to read about how other doctors are impressed by their work). The pulmonologist actually wrote "looks awful". The hospitalist wrote "prognosis extremely grim". The nephrologist wasn't too impressed either. I was flabbergasted. Well, now he's post op day #6 and he's out of the ICU. Not so "awful" anymore......

6 comments:

Bongi said...

this is one of the reasons i don't like other people looking after my icu patients.

rlbates said...

It helps that you saw how he looked preop. I remind the OR crew after we do a major panniculectomy and they comment on how good it looks that they saw "how bad it was". Without that reference point, sometimes I don't even think my work looks good.

Anonymous said...

If you don't want another's opinion/expertise, then don't ask for consultations.

Buckeye Surgeon said...

Anon-
What are you talking about? The point of the post was to demonstrate the differing impressions doctors from different specialties have on complicated, sick patients. I thought it was amusing that, here I was , all gung ho that the patient was ALIVE, and everyone else saw something quite diffrent. Besides I didn't consult those specialists; I was a late addition to the doctor parade on this particular guy.

Anonymous said...

NO, actually the "point" of your rant was to stick it to the other consultants as evidenced by your statement:

"was flabbergasted. Well, now he's post op day #6 and he's out of the ICU. Not so "awful" anymore......"

Buckeye Surgeon said...

Oh Anon- You are so wise informing of my true intentions. We've gone through this before. You believe I'm an "asshole" surgeon who rips other specialties. Here's a fun time: try looking up the word "flabbergasted" in something like, oh, I dont know, the dictionary. It means totally surprised or shocked. It actually does NOT mean "stick it to other doctors"....I'm glad I provide so much joyful entertainment for you, kind sir. Please keep enjoying the blog!